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Predicting the severity of acute pancreatitis: Current approaches and future directions 预测急性胰腺炎的严重程度:当前方法和未来方向
IF 1.4 Q3 Medicine Pub Date : 2024-03-27 DOI: 10.1016/j.sopen.2024.03.012
Aida Metri, Nikhil Bush, Vikesh K. Singh MD, MSc

Acute pancreatitis (AP) is a sudden-onset inflammatory disease of the pancreas. The severity of AP is classified into mild, moderate, and severe categories based on the presence and persistence of organ failure. Severe acute pancreatitis (SAP) can be associated with significant morbidity and mortality. It requires early recognition for appropriate timely management. Prognostic scores for predicting SAP incorporating many clinical, laboratory, and radiological parameters have been developed in the past. However, all of these prognostic scores have low positive predictive value for SAP and some of these scores require >24 h for assessment. There is a need to develop biomarkers that can accurately identify patients at risk for SAP early in the course of the presentation. In this review, we aim to provide a summary of the most commonly utilized prognostic scores for AP and discuss future directions.

急性胰腺炎(AP)是一种突发的胰腺炎症性疾病。根据器官衰竭的存在和持续情况,急性胰腺炎的严重程度可分为轻度、中度和重度。重症急性胰腺炎(SAP)可导致严重的发病率和死亡率。重症急性胰腺炎需要早期识别,以便及时采取适当的治疗措施。过去已开发出预测 SAP 的预后评分,其中包含许多临床、实验室和放射学参数。然而,所有这些预后评分对 SAP 的阳性预测值都很低,其中一些评分需要 24 小时才能进行评估。因此,有必要开发生物标志物,以便在患者发病早期就能准确识别有 SAP 风险的患者。在这篇综述中,我们旨在总结最常用的 AP 预后评分,并讨论未来的发展方向。
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引用次数: 0
Is the robotic revolution stunting surgical skills? 机器人革命是否阻碍了外科技术的发展?
IF 1.4 Q3 Medicine Pub Date : 2024-03-27 DOI: 10.1016/j.sopen.2024.03.009
Damien J. Lazar MD MBA, George S. Ferzli MD FACS

This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow.

Key message

The large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.

本视角文章旨在研究普通外科和微创外科手术中机器人平台的日益广泛应用对外科学员的经验、技能水平以及完成培训后执行普通外科和微创手术的舒适度的影响。我们回顾了当前的文献,并探讨了机器人手术在外科培训中的应用,在外科培训中,最低病例阈值和广度分布都有明确规定,手术技巧的发展历来是通过触觉反馈的精细组织处理而非仅仅依靠视觉反馈获得的。我们呼吁慎重考虑如何最好地将机器人技术纳入外科培训,以便在拥抱技术进步的同时,不危及未来外科医生的手术熟练程度。关键信息在当今世界,将机器人技术大规模纳入普通和微创外科培训是大多数(如果不是全部)受训者必须面对的问题,而且机器人技术所占的比例正在增加。这种转变可能会对受训者完成培训后的手术技能产生重大负面影响,因此必须以适当的关注和深思熟虑的态度来对待,以保护未来的外科医生。
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引用次数: 0
Efficacy of damage control orthopedics strategy in the management of lower limb trauma 损伤控制矫形策略在治疗下肢创伤中的功效
IF 1.4 Q3 Medicine Pub Date : 2024-03-26 DOI: 10.1016/j.sopen.2024.03.008
Fubin Li, Lecai Gao, Jiangang Zuo, Jindong Wei

Background

Little is known about the efficacy of damage control (DC) surgery in the management of lower limb trauma. Here we compared the clinical parameters and complication rates of such patients received either DC or emergency comprehensive (EC) surgery treatment.

Methods

This study is a retrospective study on patients with lower limb trauma that received surgical treatment. Data of 120 patients were divided into DC and EC surgery groups. Clinical parameters obtained at hospital admission and complications during follow-up were analyzed. Injury Severity Score (ISS), Gustilo classification and Mangled Extremity Severity Score (MESS) were used to assess trauma severity, open fractures and viability of injured limb, respectively.

Results

Age, sex, ISS, fracture type, injury site, MESS, operation time, blood loss, pulmonary and cranial injuries were compared. We found that patients in the DC group had more severe injury as reflected by the higher injury severity score (ISS) (28.1 ± 10.9 vs 21.3 ± 7.4, P < 0.001). ISS was also identified as a significant influencer for the treatment selection (P < 0.001). In addition, patients treated with DC surgery demonstrated less complications (7 cases vs 27 cases), which was supported by the propensity score logistic regression analysis (Odd ratio 4.667).

Conclusions

DC surgery is more often selected to treat patients with more severe lower limb injuries, which leads to lower complication rates.

背景人们对损伤控制(DC)手术治疗下肢创伤的疗效知之甚少。在此,我们比较了接受DC或紧急综合(EC)手术治疗的此类患者的临床参数和并发症发生率。120例患者的数据被分为DC手术组和EC手术组。分析入院时的临床参数和随访期间的并发症。结果 比较了年龄、性别、ISS、骨折类型、受伤部位、MESS、手术时间、失血量、肺部和颅脑损伤。我们发现,直流电组患者的损伤严重程度(ISS)更高(28.1 ± 10.9 vs 21.3 ± 7.4,P < 0.001),这反映出直流电组患者的损伤更严重。ISS 也被认为是影响治疗选择的重要因素(P < 0.001)。此外,接受 DC 手术治疗的患者并发症较少(7 例 vs 27 例),倾向评分逻辑回归分析(奇数比 4.667)也支持这一点。
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引用次数: 0
Factors affecting minimally invasive surgery utilization during elective colectomies for diverticular disease in the United States 影响美国憩室疾病择期结肠切除术中微创手术利用率的因素
IF 1.4 Q3 Medicine Pub Date : 2024-03-26 DOI: 10.1016/j.sopen.2024.03.007
Arshad M. Bachelani , Laura A. Holton

Background

Compared with open surgery, minimally invasive surgery (MIS) has been shown to have improved outcomes when treating diverticular disease. This study aimed to analyze recent trends in MIS utilization for elective colectomy for diverticular disease and to identify individual variables and hospital characteristics associated with MIS utilization.

Methods

This population-based study examined individuals from the National Inpatient Sample who underwent elective colectomy for diverticular disease from 2016 to 2019.

Results

Hospitals in the Midwest used MIS less than those in other geographic regions. Rural hospitals used MIS less than urban hospitals. Hospital bed size and teaching status were not associated with differences in MIS utilization. Patients with private insurance were more likely to have an MIS operation. There was also a racial disparity in MIS utilization, even after adjusting for insurance status.

Conclusions

While there is no longer any variance in MIS utilization based on hospital bed size or teaching status, disparities concerning patient race remain, even after adjusting for insurance status. Further investigation is needed to determine the roots of these disparities.

背景与开腹手术相比,微创手术(MIS)治疗憩室疾病的效果更好。本研究旨在分析憩室疾病择期结肠切除术中MIS使用的最新趋势,并确定与MIS使用相关的个体变量和医院特征。结果中西部地区的医院比其他地区的医院更少使用MIS。农村医院比城市医院更少使用MIS。医院床位规模和教学状况与MIS使用率的差异无关。有私人保险的患者更有可能接受 MIS 手术。结论虽然医院床位规模或教学状况不再导致MIS使用率的差异,但即使调整了保险状况,患者的种族差异依然存在。需要进一步调查以确定这些差异的根源。
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引用次数: 0
Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a rummel tourniquet 使用 ECMO 的高危患者的气管切开术:利用鲁梅尔止血带的床旁混合扩张技术
IF 1.4 Q3 Medicine Pub Date : 2024-03-24 DOI: 10.1016/j.sopen.2024.03.004
Mark Falimirski
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引用次数: 0
Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis 药物滥用障碍与腹部大手术结果的关系:当代国家分析
IF 1.4 Q3 Medicine Pub Date : 2024-03-22 DOI: 10.1016/j.sopen.2024.03.006
Baran Khoraminejad , Sara Sakowitz MS MPH , Zihan Gao MHSc , Nikhil Chervu MD , Joanna Curry BA , Konmal Ali , Syed Shahyan Bakhtiyar MD MBE , Peyman Benharash MD MS

Background

Affecting >20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations.

Methods

All adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016–2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the SUD cohort (others: nSUD). Multivariable regression models were constructed to evaluate the independent association between SUD and key outcomes.

Results

Of ∼1,088,145 patients, 32,865 (3.0 %) comprised the SUD cohort. On average, SUD patients were younger, more commonly male, of lowest quartile income, and of Black race. SUD patients less frequently underwent colectomy, but more often pancreatectomy, relative to nSUD.

Following risk adjustment and with nSUD as reference, SUD demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09–1.25). Further, SUD was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68–1.12) and costs (β + $3630, CI +2650–4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40–1.70).

Conclusions

Concurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.

背景美国有 2,000 万人受到药物使用障碍(SUD)的影响,占住院患者总数的 4%,这是一个日益严重的公共卫生危机。我们评估了一个全国性队列,旨在描述择期腹部手术后并发 SUD 与围手术期结果和资源利用的关系。方法从 2016-2020 年全国住院病人样本中统计了所有需要进行择期结肠切除术、胃切除术、食管切除术、肝切除术和胰切除术的成人住院病人。同时患有药物使用障碍(包括酒精、阿片类药物、大麻、镇静剂、可卡因、吸入剂、致幻剂或其他精神活性剂/兴奋剂的使用)的患者被视为SUD队列(其他:nSUD)。结果 在 1,088,145 名患者中,有 32,865 人(3.0%)属于 SUD 群体。SUD 患者平均年龄较轻,多为男性,收入处于最低四分位数,且为黑人。在进行风险调整并以 nSUD 作为参照后,SUD 显示出相似的院内死亡率,但仍与围手术期并发症几率的增加有关(调整后比值比 [AOR] 1.17,CI 1.09-1.25)。此外,药物滥用与调整后住院时间(β + 0.90 天,CI +0.68-1.12)和费用(β + 3630 美元,CI +2650-4610)的递增以及非居家出院可能性的增加有关(AOR 1.54,CI 1.40-1.70)。需要采取新的干预措施来应对这一弱势群体的风险增加,并解决术后结果的显著差异。
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引用次数: 0
HPB ultrasound guidance techniques - Targeting HPB 超声引导技术 - 定位
IF 1.4 Q3 Medicine Pub Date : 2024-03-13 DOI: 10.1016/j.sopen.2024.02.013
Matthew S. Strand, David A. Iannitti

Ultrasound is an indispensable tool for intraoperative assessment and treatment of hepatopancreatobiliary pathology. As minimally invasive approaches to HPB surgery continue to expand and the benefits of parenchymal-sparing liver surgery are increasingly appreciated, skillful targeting will play an even bigger role in HPB surgical practice. Techniques for intraoperative targeting of liver lesions for the purposes of biopsy and ablation, particularly in the laparoscopic setting, are the focus of this chapter.

Current evidence supports the use of ablation for a variety of liver lesions including hepatocellular carcinoma and metastatic colorectal cancer, particularly for smaller lesions.

Successful targeting requires optimization of patient position and port placement. When targeting multiple lesions, thoughtful treatment sequencing is critical to maintaining visualization and optimizing outcomes.

超声波是术中评估和治疗肝胆胰病理不可或缺的工具。随着肝胆胰外科微创方法的不断扩大,以及人们越来越重视保肝手术的益处,娴熟的定位技术将在肝胆胰外科实践中发挥更大的作用。目前的证据支持对包括肝细胞癌和转移性结肠直肠癌在内的多种肝脏病变进行消融治疗,尤其是对较小的病变,成功的靶向治疗需要优化患者体位和端口放置。在针对多个病灶进行治疗时,周到的治疗排序对于保持可视化和优化治疗效果至关重要。
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引用次数: 0
Editorial Board Page 编辑委员会页面
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/S2589-8450(24)00043-5
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引用次数: 0
Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery 大手术后院内阿片类药物过量的趋势、结果和相关因素
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.03.002
Joanna Curry , Troy Coaston , Amulya Vadlakonda , Sara Sakowitz , Saad Mallick , Nikhil Chervu , Baran Khoraminejad , Peyman Benharash

Background

With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations.

Methods

We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016–2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as OD (others: Non-OD). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge.

Results

Of an estimated 11,096,064 hospitalizations meeting study criteria, 5375 (0.05 %) experienced a perioperative OD. Compared to others, OD were older (66 [57–73] vs 64 [54–72] years, p < 0.001), more commonly female (66.3 vs 56.7 %, p < 0.001), and in the lowest income quartile (26.4 vs 23.2 %, p < 0.001). After adjustment, female sex (Adjusted Odds Ratio [AOR] 1.68, 95 % Confidence Interval [CI] 1.47–1.91, p < 0.001), White race (AOR 1.19, CI 1.01–1.42, p = 0.04), and history of substance use disorder (AOR 2.51, CI 1.87–3.37, p < 0.001) were associated with greater likelihood of OD. Finally, OD was associated with increased LOS (β +1.91 days, CI [1.60–2.21], p < 0.001), hospitalization costs (β +$7500, CI [5900–9100], p < 0.001), and greater odds of non-home discharge (AOR 2.00, CI 1.61–2.48, p < 0.001).

Conclusion

Perioperative OD remains a rare but costly complication after elective surgery. While pain control remains a priority postoperatively, protocols and recovery pathways must be re-examined to ensure patient safety.

背景随着阿片类药物在美国日益流行,阿片类药物的院内使用也越来越受到关注。本研究利用全国性队列,试图描述重大择期手术后院内阿片类药物过量(OD)的趋势、结果和相关因素。院内阿片类药物过量的患者被定性为OD(其他:非OD)。主要研究结果为院内阿片类药物过量。我们建立了多变量逻辑回归和线性回归模型,以评估院内 OD 与死亡率、住院时间(LOS)、住院费用和非家庭出院之间的关系。与其他人相比,OD 的年龄更大(66 [57-73] 岁 vs 64 [54-72] 岁,p < 0.001),更常见的是女性(66.3 vs 56.7 %,p < 0.001)和最低收入四分位数(26.4 vs 23.2 %,p < 0.001)。经调整后,女性性别(调整比值比 [AOR] 1.68,95% 置信区间 [CI] 1.47-1.91,p <0.001)、白种人(AOR 1.19,CI 1.01-1.42,p = 0.04)和药物使用障碍史(AOR 2.51,CI 1.87-3.37,p <0.001)与发生 OD 的可能性增加有关。最后,OD 与 LOS 增加(β +1.91 天,CI [1.60-2.21],p <0.001)、住院费用增加(β +$7500, CI [5900-9100],p <0.001)和非家庭出院几率增加(AOR 2.00, CI 1.61-2.48,p <0.001)有关。虽然疼痛控制仍是术后的首要任务,但必须重新审查规程和恢复路径,以确保患者安全。
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引用次数: 0
Correlation between research productivity during and after orthopaedic surgery training 矫形外科培训期间和培训结束后的研究成果之间的相关性
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.02.010
Daniel Acevedo , Henson Destiné , Christopher J. Murdock , Dawn LaPorte , Amiethab A. Aiyer

Background

Research experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons.

Methods

Using the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training.

Results

As defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, P < 0.001. The range of publication post-training was 0–124 vs. 0–30 during training. Pearson correlation between the two groups resulted in a value of 0.654, P < 0.001.

Conclusion

Higher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.

背景研究经历是所有骨科住院医师培训项目的必修课程。尽管各项目分配的所需保护时间和资源各不相同,但研究的根本重要性始终如一,对住院医师、项目和教师都是互惠互利的。作者身份和出版物已成为评估学术成就的标准指标。本研究旨在确定矫形外科受训者的研究生产率与他们作为矫形外科主治医师的后续研究生产率之间是否存在关联。方法利用密西西比大学矫形外科住院医师项目研究生产率排名表,分析了 30 个不同的矫形外科住院医师项目,以了解其 2013 届毕业的每一位外科医生的姓名。利用 PubMed Central 筛选了所有 156 名医生,并收集了他们在 2008 年至 2022 年 8 月期间发表的所有论文。结果分为两类:结果如上所述,对 156 名外科医生在培训期间和培训后发表的论文进行了分析。培训后发表论文的平均数量为 7.02 ± 17.819 篇,培训期间为 2.47 ± 4.313 篇,P < 0.001。培训后发表论文的范围为 0-124 篇,而培训期间为 0-30 篇。两组之间的 Pearson 相关性值为 0.654,P <0.001。结论培训期间的研究生产率越高,培训后的生产率也越高,但总体而言,骨科外科医生在培训后的研究成果要多于培训期间。随着研究的重要性与日俱增,必须为研究提供更多的指导、时间和资源,以灌输和促进在培训期间更多地参与研究。
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引用次数: 0
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Surgery open science
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